Abstract
This study aimed to compare Korean smokers’ smoking-related biomarker levels by tobacco product type, including heat-not-burn cigarettes (HNBC), liquid e-cigarettes (EC), and traditional cigarettes (TC). Nicotine dependence levels were evaluated in Korean adult study participants including TC-, EC-, HNBC-only users and nonsmokers (n = 1586) from March 2019 to July 2019 in Seoul and Cheonan/Asan South Korea using the Fagerström Test Score. Additionally, urine samples (n = 832) were collected for the measurement of urinary nicotine, cotinine, OH-cotinine, NNAL(4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), CYMA(N-acetyl-S-(2-cyanoehtyl)-L-cysteine), or CEMA (2-cyanoethylmercapturic acid) using LC–MS/MS. The median(interquartile range) nicotine dependence level was not different among the three types of smokers, being 3.0 (2.0–5.0) for TC- (n = 726), 3.0 (1.0–4.0) for EC- (n = 316), and 3.0 (2.0–4.0) for HNBC- (n = 377) only users. HNBC-only users presented similar biomarker levels compared to TC-only users, except for NNAL (HNBC: 14.5 (4.0–58.8) pg/mL, TC: 32.0 (4.0–69.6) pg/mL; p = 0.0106) and CEMA (HNBC: 60.4 (10.0–232.0) ng/mL, TC: 166.1 (25.3–532.1) ng/mL; p = 0.0007). TC and HNBC users showed increased urinary cotinine levels as early as the time after the first smoke of the day. EC users’ biomarker levels were possibly lower than TC or HNBC users’ but higher than those of non-smokers.
Highlights
Cigarette smoking remains a major health concern worldwide
We found that there was a dose–response relationship between urinary cotinine levels and daily smoking amounts (6–10 cigarettes followed by 11–15 cigarettes, compared to 5 or less cigarettes), among traditional cigarettes (TC) (p < 0.05) or heat-not-burn cigarettes (HNBC) (p < 0.05) users after adjusting for age and sex
We found that the median values of urinary cotinine, OH-cotinine, and nicotine among TC-users were 730, 2227, and 1121 ng/mL, respectively, and the median values of CYMA and CEMA were 180 and 166 ng/m, respectively
Summary
Cigarette smoking remains a major health concern worldwide. In South Korea, approximately 37% of Korean adult males and 5.2% of Korean adult females were found to be smokers in 2017 [4]. Various electronic nicotine delivery systems (ENDS), including liquid ecigarettes (EC) and heat-not-burn cigarettes (HNBC), have been widely used as alternatives to traditional cigarettes (TC). HNBC, which is a type of cigarette heated with an electric blade at 350 ◦ C, gives the smoker the true taste of tobacco, with reduced smoke and smell. The preference of smokers has been shifting from TC to EC and HNBC. This change in smoking patterns raises major issues such as the biochemical harmfulness of ENDS to humans, as warned by global health organizations, including the CDC and the World
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